Level Two Exchange Establishment Grants, which are multi-year awards to help states further develop their marketplaces, were awarded to five states: California, Kentucky, Massachusetts, New York and Oregon. A total of 49 states, the District of Columbia, and four territories have received grants to plan their marketplaces, and 34 states and the District of Columbia have received grants to build their marketplaces.

To date 18 states and the District of Columbia have been conditionally approved to operate state-based exchanges. The federal government will establish and operate health insurance marketplaces (exchanges) in those states that do not establish their own.

Arkansas and Delaware have been conditionally approved to operate a state partnership exchange, a hybrid model that allows states to assume primary responsibility for many of the functions of the exchange facilitated by the federal government. All exchanges will launch open enrollment in October 2013.